Merete Bakke

Musculoskeletal disorders among dentists and variation in dental work

The purpose was to assess risk factors in dentistry which may contribute to musculoskeletal disorders. A questionnaire was used to identify common work tasks, and to estimate one year prevalence for troubles (65% for the neck/shoulder, 59% for the low back). In a field study working postures and electromyography (shoulder/neck) were registered during the three most common work tasks. Prolonged neck flexion and upper arm abduction were found, as well as high static muscle activity levels (splenius and trapezius muscles). No differences between work tasks were found regarding postures, frequencies of movements or muscle activity. Alterations between the three work tasks do not produce sufficient variation to reduce musculoskeletal load on the neck and shoulders.

Ultra sonographic assessment of the swelling of the human masseter muscle after static and dynamic activity

Work-related fatigue, pain and disorders in skeletal muscles have been related to prolonged static and dynamic activity. Such contractions have been shown to impair blood flow and increase muscle thickness and fluid. In the present study the effect of static and dynamic activity was evaluated from changes in masseter thickness as a measure of oedema, simultaneously with assessment of perceived pain/discomfort and cardiovascular responses. As static activity, fourteen young healthy women bit at 15% maximal voluntary contraction on bite-force transducers in the molar regions until exhaustion or 20 min at maximum (median endurance time 7.1 min). For dynamic activity, the same individuals chewed gum unilaterally until exhaustion or 40 min at maximum (all endured 40 min) with a cycle time of 725 ms, an average load of 9.3% of maximal electromyographic activity (maxEMG) and a peak mean voltage of 54.3% of maxEMG. Muscle thickness was measured by ultrasonography at the mid-portion of the ipsilateral masseter. Immediately after exercise, muscle thickness was significantly increased, more after static (14.0%) than dynamic (8.6%), and returned to pre-exercise values after 20-min recovery. Visual analogue scales (VAS) revealed the concomitant occurrence of pain (static 11.9 VAS%; dynamic 5.9 VAS%), and discomfort (static 8.1 VAS%; dynamic 5.9 VAS%), and both sensations decreased to pre-exercise values after 20-min recovery. Systolic blood pressure increased significantly, more during static (12.5%) than dynamic activity (4.3%), whereas heart rate rose significantly only during dynamic exercise (13.3%). Hence, activity was associated with muscular swelling and pain, and, despite the relatively small size of the masticatory muscles, also with general cardiovascular responses.

Effects of ethnicity, gender and age on clenching force and load distribution.

Abstract The aim of the study was to investigate the effect of ethnicity, gender and age on the degree of clenching force and distribution of the load over the dentition. The maximal clenching force was measured in 12 young Danish females, 12 young Japanese females, 12 young Japanese males and 10 senior Japanese males using the Dental Prescale System. The occlusal contact area, average pressure, occlusal load, antero-posterior and right-left location of the occlusal load center (i.e., a center of balance of the occlusal load distributed over the maxillary dentition: OLC) and dental arch length and width were analyzed and compared. The arch width and average pressure in young Danish females were significantly smaller/lower than in Japanese females. The arch length, arch width, contact area and total occlusal load in young Japanese males were significantly greater than those of the Japanese females. The average pressure in young Japanese males was also greater than in senior males. The location of the OLC was almost the same in all groups. The results suggest that the analysis of the OLC may be a useful method for evaluating occlusal function and prosthodontic treatment because the location of the OLC is not affected by ethnicity, gender and age.

Salivary Cortisol Level, Salivary Flow Rate, and Masticatory Muscle Activity in Response to Acute Mental Stress: A Comparison between Aged and Young Women

Background: Age-related effects on physiological stress reactions regarding changes in salivary cortisol concentration, saliva flow rate, and masticatory muscle activity, as well as the corresponding perceived mental stress and performance in response to acute stressors, have not yet been fully described. Objective: Thus, the aim of this study was to assess the age-related variations in these variables in response to minor acute and naturalistic stressors in terms of computer tasks. Methods: 13 aged (60–70 years old) and 13 young (20–30 years old) women with frequent practice and long experience with computer use were recruited by personal contact and flyers. The subjects were healthy and had full dental arches and no orofacial pain. The computer tasks were randomized and comprised a mentally demanding, modified Stroop colour-word test (CWT) and a less demanding reference test, both with a duration of 20 min and with equal physical demand. Visual analogue scales for global assessment of mental stress and perceived task difficulty and performance, measurements of saliva flow rate and cortisol concentration (unstimulated whole saliva), as well as surface electromyography of the temporalis and masseter muscles were used for assessment, and Spearman correlation analysis and Anova with repeated measures were used for statistical evaluation. Results: The perceived task-related stress and task difficulty were significantly higher and the personal satisfaction with the task performance significantly poorer in the aged women. The cortisol concentration, indicating the stress level, showed a small, but significant increase in response to the tasks. Also the saliva flow rate increased. This response was most pronounced in the aged and during the CWT. The average electromyogram varied significantly between age groups and tasks, with higher levels and shorter relative periods with gaps in the aged women and in the CWT. In addition, the peak activity of the jaw elevator muscles at mouse clicking was significantly elevated as a form of co-activation or attention-related activity. Conclusions: The study showed marked differences in the response to mental demands in aged as compared with young women. The mental stress, reflected by increases of salivary cortisol concentration, saliva flow rate, visual analogue scale ratings, and activity level of the jaw elevator muscles, was more pronounced in the aged women in response to the computer tasks.

Jaw Muscle Soreness after Tooth-clenching Depends on Force Level

The effects of prolonged tooth-clenching on masticatory muscle pain have not been fully elucidated. We hypothesized that late-onset soreness may develop depending on the clenching force. Ten pain-free females were asked to endure sustained clenching tasks up to exhaustion in randomized sequences of 7.5%, 10%, 15%, 25%, and 40% of maximum clenching force. Perceived pain, fatigue, and pressure-pain thresholds of masseter and temporalis muscles were assessed before, immediately after, and one day after the tasks. Endurance times differed markedly among participants and force levels, ranging from 1.2 to 245.1 min. Masseter pressure-pain threshold decreased immediately after (-13.7%; p = 0.050) and one day after (-22.0%; p = 0.006) the 7.5% task. Temporalis pressure threshold decreased one day after the 7.5 % task (-14.6%; p = 0.003). It was concluded that prolonged low-level tooth-clenching in healthy young women induces a delayed soreness in the jaw elevator muscles.

Release of peppermint flavour compounds from chewing gum: effect of oral functions

During chewing, the oral cavity functions like a bellow, forcing volatile flavour compounds into the exhaling air to the nasal compartment. Accordingly, we hypothesised that flavour release from chewing gum is predominantly governed by chewing frequency (CF), although other oral functions, like masseter muscle activity (MMA), chewing force (CFO), and saliva flow rate (SFR), may also play a role. In 10 healthy young males, the retronasal expired air of menthol and menthone from peppermint-flavoured (2%) chewing gum was determined as functions of CF, SFR, MMA, and CFO. The experimental setup comprised three separate series of a 4-min chewing period. These series differed only with respect to CF, i.e., habitual frequency, and 60 and 88 strokes/min. Results showed that more than 50% of the released menthol and menthone could be retrieved in the expired air and saliva. After 2-min of chewing, the concentration of flavour compounds in the expired air depended primarily on MMA and CF, becoming higher with increased MMA and CF. The concentration of flavour compounds in saliva depended primarily on SFR and the duration of the chewing task, becoming lower with high SFR and prolonged chewing duration. An increased volume of saliva in the mouth seemed to keep more flavour compounds in the aqueous phase, thereby diminishing the release via the retronasal route. In conclusion, flavour release to the retronasal compartment was dependent on MMA and CF and influenced by the volume of saliva present in the mouth.

Quantitative ultrasound tissue characterization in shoulder and thigh muscles – a new approach

BackgroundThe echogenicity patterns of ultrasound scans contain information of tissue composition in muscles. The aim was: (1) to develop a quantitative ultrasound image analysis to characterize tissue composition in terms of intensity and structure of the ultrasound images, and (2) to use the method for characterization of ultrasound images of the supraspinatus muscle, and the vastus lateralis muscle.MethodsComputerized texture analyses employing first-order and higher-order grey-scale statistics were developed to objectively characterize ultrasound images of m. supraspinatus and m. vastus lateralis from 9 healthy participants.ResultsThe mean grey-scale intensity was higher in the vastus lateralis muscle (p < 0.05) than in the supraspinatus muscle (average value of middle measuring site 51.4 compared to 35.0). Furthermore, the number of spatially connected and homogeneous regions (blobs) was higher in the vastus lateralis (p < 0.05) than in the supraspinatus (average for m. vastus lateralis: 0.092 mm-2 and for m. supraspinatus: 0.016 mm-2).ConclusionThe higher intensity and the higher number of blobs in the vastus lateralis muscle indicates that the thigh muscle contained more non-contractile components than the supraspinatus muscle, and that the muscle was coarser. The image analyses supplemented each other and gave a more complete description of the tissue composition in the muscle than the mean grey-scale value alone.

Oromandibular dystonia involving the lateral pterygoid muscles: four cases with different complexity.

The report describes oromandibular dystonia (OMD) in four women with involuntary activity of the lateral pterygoid muscles (LP), causing incapacitating protrusive and lateral jaw movements and displacements, and treatment with botulinum toxin type A (BTX). For initial survey and treatment control, OMD was analyzed with several, independent, and standardized methods. OMD severity and functional difficulties were evaluated subjectively and scored from videotapes. Jaw movements were assessed graphically with a magnetic tracking system, and electromyographical activity (EMG) of LP was recorded with needle electrodes using an intraoral approach, whereas activity of masseter muscles was recorded with surface electrodes. EMG‐guided BTX injections (25–40 units Botox per muscle) into the muscles were performed with cannula electrodes. Compared with reference values for LP, OMD was associated with a markedly increased level of spontaneous activity, but almost normal level of maximum voluntary activity. The central pattern generator for mastication seemed to override the dystonic activity, as all patients were able to chew despite some distortion. BTX reduced both the spontaneous and the maximum activity for 3–9 months. Concomitantly, a marked reduction of the OMD severity, mandibular movements and functional disturbances were also present with the best effect in localized OMD with late onset.

Quantitative ultrasound image analysis of the supraspinatus muscle

OBJECTIVE To develop and validate a method, based on quantitative ultrasound image analysis, to objectively analyse and characterize the ultrasound images of m. supraspinatus. DESIGN Quantitative ultrasonography was performed on the supraspinatus muscle of 14 healthy subjects. METHODS A computerized analysis using first-order grey-scale statistics to evaluate the muscle tissue composition was developed and validated. RESULTS Data from one scanning site were not representative for the whole muscle due to muscle inhomogenity. Using first-order grey-scale statistics the scanning direction was of no importance. By using a scanning session consisting of three different scanning sites along the muscle in two directions, longitudinally and transversely, to characterize the tissue composition of the muscle, a high day-to-day reproducibility was obtained. CONCLUSION The described scanning session is a relatively sensitive and reproducible method for studying the muscle tissue composition. RelevanceQuantitative ultrasonography seems to be a potential clinical and occupational examination method to detect tissue composition of myalgic muscles compared to healthy muscles.

Morphine application to peripheral tissues modulates nociceptive jaw reflex.

THIS study assessed the effect of peripherally applied opioids on the electromyographic activity reflexly evoked in digastric and masseter muscles by injection of the small-fiber excitant and inflammatory irritant mustard oil (MO) into the temporomandibular joint. In 39 anaesthetized rats, local pretreatment of joint tissues with morphine (15 nmol) significantly depressed the jaw muscle responses compared with saline, and the depression was antagonized by simultaneous local injection of the opiate antagonist naloxone (2.7 nmol); systemic morphine pretreatment (15 nmol, i.v.) did not influence the muscle responses. The naloxone-reversible depression of the MO-evoked muscle responses by local, but not systemic morphine, supports the presence of peripheral opioid receptors that may have a role in modulating nociceptive responses.